Provider Information for 1154554152
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
ANGELA WINCHESTER
Sex: Female
NPI: 1154554152
Last Updated: 2024-07-02
Certification Date: 2024-07-02
Certification Date: 2024-07-02
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1154554152 | ||||||||
| Enumeration Date | 2009-08-25 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1004 REDWOOD ST IDAHO FALLS, ID 83401-2946 United States Phone: 208-709-2684 | Fax: | ||||||||
| Primary Practice Address | 2420 E 25TH ST # A IDAHO FALLS, ID 83404-7549 United States Phone: 208-543-1026 | Fax: | ||||||||
| Secondary Practice Address(es) | |||||||||
| Health Information Exchange |
| ||||||||
| Other Identifiers |
| ||||||||
| Taxonomy |
|